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Earning points and small amounts of money encouraged patients with high risk for cardiovascular disease to increase their daily walking by about 10%.

Earning points and small amounts of money encouraged patients with high risk for cardiovascular disease to increase their daily walking by about 10%. Patients who received both gamification and financial incentives significantly increased their daily steps up to 18 months.

The BE ACTIVE (NCT03911141) study enrolled 1,062 participants with a 10-year atherosclerotic cardiovascular disease event risk of more than 7.5% or established vascular disease, with a median age of 67 years.¹ The study, presented by Alexander Fanaroff, MD, aimed to determine the effectiveness of a single intervention or combination intervention compared with control for increasing physical activity over a 12-month intervention and 6-month follow-up period. The study’s primary endpoint was the change in daily steps from baseline to 12 months.

Each participant received a fitness tracker that uploaded their daily step count to a secure website. At baseline, the participants’ average daily step count was approximately 5,000 steps. Each participant selected a goal to increase their daily step count by at least 1,500 steps more than their current level. The study team randomly assigned participants to one of four groups. The control group received daily text messages with their step counts. The gamification group played a weekly game with loss-framed points and levels. The financial incentive group received loss-framed financial rewards (up to $14 weekly in a virtual account). The fourth group received both gamification and financial incentives.

At 12 months, all intervention groups had significantly greater increases in mean daily steps from baseline compared with the control group. Participants in the gamification group achieved an adjusted difference of 538.0 steps compared with the control group (95% CI 186.2–889.9; P=0.0027). Those in the financial incentives group had 492 more steps (95% CI 139.6–844.1; P=0.0062) than the control group. The combined approach was the most successful; participants increased their daily steps by 2,297 steps from baseline, 868 more steps per day than the control group (95% CI 516.3–1219.7; P<0.001).

At the 18-month follow-up, only the combination group showed a statistically significant increase in daily steps compared with the control (adjusted difference 576.2 steps; 95% CI 198.5–954; P=0.0028). However, all intervention groups had a numerical average daily step increase of more than 1,500 compared with baseline.

Medical writing support was provided by Dr. Susanne Kammerer.
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